Provider Demographics
NPI:1639473994
Name:LUMSDEN, WILEY EVERETT (RPH)
Entity type:Individual
Prefix:MR
First Name:WILEY
Middle Name:EVERETT
Last Name:LUMSDEN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11060 HIGHWAY 238
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97530-9604
Mailing Address - Country:US
Mailing Address - Phone:541-899-1505
Mailing Address - Fax:541-665-2209
Practice Address - Street 1:136 E PINE ST
Practice Address - Street 2:
Practice Address - City:CENTRAL POINT
Practice Address - State:OR
Practice Address - Zip Code:97502-2250
Practice Address - Country:US
Practice Address - Phone:541-665-2140
Practice Address - Fax:541-665-2209
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-30
Last Update Date:2010-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6645183500000X
CA32434183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist